today

[Guest guest]

so here's what I just did I have this older guy very frail Parkinson's and myelodysplasia and well lots of things and a recent fall with sacral fx and an admit ( much confusion the ct did not mention the fx the orthopod said there was a fx someone ordered a bone scan the family said is there or isnt there a fx, I call radiology they say of course there is I say umm the report doesn't mention it they say - oh, and he got a fever and some resp infection and he has trouble swallowing and was ? aspiraitng and went to the NH to rehab but got readmitted to hospital and anyway -- He is doing poorly ,right, so I say to family we need to get together and talk .I am thinking hospice or well various issues have come up .I say Can family come up (to maine?)

NO cannot do ,has 4 kids, hours away.But the son arranges a call-in conference call and I call IT at hospital who brings this wicked cool speaker phone to the room PAtietn has a tiny voice but all 5 people in the phone could hear their Dad- one is former colleague of mine a pediatrician and we have a great family mtg ( I get the hospitalist to consult me to do the work) and we discuss all the issues make a plan answer all the questions . 45min .They do a group electronic hug , I report to the hospitlaist who is more than glad to have me do all this and the guy gets good ,not overdone , no mistakes care.

Maine -it says on t he turnpike - the way life should be.Boy that was really nice Efficient compensated totally excellent primary care. In the hospital.

Waking the public to what's wrong

with health care is an essential ingredient in reform.

Use this message widely. Discuss it

with your patients. One of the major drivers of dysfunction, pain, and

cost is the burden of the administrative trivia. Business Human Resources

heads will purchase a benefits package that has the promise of lower cost due

to insurance company moves like "pharmacy benefits management," "disease

management," and "case management." Using a narrow

focus financial analysis these interventions look good (in the short term), but

- taking the long term or widening the financial analysis to account for the

increased costs in our practices, the ramped up hamster wheel, the further

decline in our ability to work for our patients – one finds increased overall

cost, decreased overall satisfaction, worse overall outcomes.

Human resource executives and business

leaders are desperate for cost savings. They are fooled by the insurance

industry into believing that these interventions will lead to overall reduced

premium, improved satisfaction, higher quality. These interventions have

been around for more than a decade, giving us enough time to judge the outcome

a dismal failure. It is time for a change.

We need significant reform of the health

care system. All the high performing health systems in the world are

based on a platform of effective primary care. High performing health

systems achieve vastly superior results while averaging less than half the per

person cost of the US

health care system.

Suggest to your patients that they speak

to their human resources people at work. Tell them to stop being fooled

by false promises and interventions that look good up front and may even have

been well intended but are not only overall failures but are a major cause of

the continuing decline of health care and the imminent demise of primary care

in the U.S.

Employers are desperate, we are desperate,

and much of the public is desperate for true reform. We have to lend our

thoughts, our words, our ideas to this desperation to help focus the attention

on changes that matter.

These times require two major changes:

Primary care must be relieved of the

crushing administrative trivia that adds so little overall value.

Primary care must given adequate resources

to engage in the full scope of work that is our specialty including

coordination of care across the continuum.

The resources to adequately fund primary

care do not require an

increase in premiums. The extra money to enable effective primary care

can come initially from the millions spent annually on "disease

management" and "case management."

This initial re-allocation of resources results

in effective primary care which results in improved health and reduced cost.

The money should be distributed as a

monthly or quarterly "disease or case management" fee.

This extra money to primary care should be

directed toward those practices willing to demonstrate that they have the

ability to deliver effective primary care.

Remind your patients that we know how to

do this work. We have:

Eliminated

the barriers to access and wasted time

Superb

relationships over time

A

broad array of services that includes the ability to elicit and work with

the patient agenda (patient-centered collaborative care). We could do

so much more if we could afford the modern tools used to help us track

unmet patient needs and if we had the resources necessary to perform the

outreach and "population management."

The

ability to coordinate care across the crazy silos of health care.

Again we could do so much more to help prevent our patients from falling

through the chasms between the silos if we had the resources.

The primary care community has again and

again invested time and money in tools to help us track patients with chronic

disease, use online tools as point-of-care decision support, perform outreach

to patients with gaps in care, open ourselves to our patients after hours by

phone, email, text message. We do this work even though it is not valued

and our finances suffer – we do it because it is the right thing to do.

Your patients can talk to their employers,

their benefits managers, their legislators to urge them to do the right

thing. Americans don't need more "insurance," they need

real health care they can afford and a primary care work force that is given

the resources to do the work.

Gordon

From:

[mailto: ] On

Behalf Of

Sent: Tuesday, November 18, 2008

7:02 AM

To:

Subject: Re:

Physician's Foundation survey

Hi all:

Many of you probably saw this, but just in case here it is:

http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html

Half of all primary care doctors in the U.S. would quit if they had an

income alternative.

BUt how many plumbers and elctricians and landscapers and ffactory

workers would quit if they had an income alternative?

--

If you are a patient please allow up to 12 hours for a reply by

email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax